Provider Demographics
NPI:1467031229
Name:RUCKER, AMBER FRANCES (SUDP, CAAR, SWAICL)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:FRANCES
Last Name:RUCKER
Suffix:
Gender:
Credentials:SUDP, CAAR, SWAICL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9751 VISTA TER
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:WA
Mailing Address - Zip Code:98230-9771
Mailing Address - Country:US
Mailing Address - Phone:360-201-0002
Mailing Address - Fax:
Practice Address - Street 1:515 LAKEWAY DR
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-5233
Practice Address - Country:US
Practice Address - Phone:360-676-2187
Practice Address - Fax:360-757-0136
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO61095313101YA0400X
WASC616674181041C0700X
WACP61424877101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical